The OSCEs in Gynecology-Obstetrics: about the …wd.fmpm.uca.ma/biblio/theses/annee-htm/FT/2018/these209-18.pdf · Radiologie : LAKMICHI Mohamed Amine . Urologie : BAIZRI Hicham .
Post on 10-Sep-2018
226 Views
Preview:
Transcript
Year 2018 Thesis N° 209
The OSCE in Gynaecology and Obstetrics : About the experience of the Faculty of Medicine of
Marrakech
THESIS PRESENTED AND DEFENDED PUBLICLY THE 22/06/2018
BY Ms. Asmae KHAOUA
Born on the 07 September 1990 in Rabat
TO OBTAIN THE DEGREE OF DOCTOR OF MEDICINE
KEYWORDS: Medical Education-Assessment-Evaluation-OSCE
JURY
M. A. SOUMMANI President Professor in Gynaecology and Obstetrics Mr. K. HAROU Thesis Supervisor Professor in Gynaecology and Obstetrics Mr. H. ASMOUKI Judge Professor in Gynaecology and Obstetrics
“When you educate a man, you educate an individual. But if you educate a woman, you educate a nation.” -African Proverb “Raise your words, not voice. It is rain that grows flowers, not thunder.”
-Rumi
“If you want to know what a man’s like, take a good look at how he treats his inferiors, not his equals.” -Sirius Black “Only those who attempt the absurd can achieve the impossible.” -Albert Einstein “As you grow older, you will discover you have two hands, one for helping yourself, the other for helping others.” -Audrey Hepburn
The Hippocratic Oath At this time of being admitted as a member of the
medical profession, I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity;
The health of my patients will be my first consideration;
I will respect the secrets which are confined in me; I will maintain by all means in my power, the honor
and noble traditions of the medical profession; My colleagues will be my brothers and sisters; I will not permit consideration of religion,
nationality, race, gender, politics, socioeconomic standing or sexual orientation intervene between my
duty and my patient; I will maintain the utmost respect for human life;
even under threat, I will not use my medical knowledge contrary to laws of humanity;
I make these promises solemnly, freely and upon my honor.
List of Professors
UNIVERSITE CADI AYYAD FACULTE DE MEDECINE ET DE PHARMACIE
MARRAKECH
Doyens Honoraires : Pr. Badie Azzaman MEHADJI
: Pr. Abdelhaq ALAOUI YAZIDI
ADMINISTRATION
Doyen : Pr. Mohammed BOUSKRAOUI
Vice doyen à la Recherche et la Coopération : Pr. Mohamed AMINE Vice doyen aux Affaires Pédagogiques : Pr. Redouane EL FEZZAZI Secrétaire Générale : Mr. Azzeddine EL HOUDAIGUI
Professeurs de l’enseignement supérieur
Nom et Prénom Spécialité Nom et Prénom Spécialité ABOULFALAH Abderrahim Gynécologie- obstétrique FINECH Benasser Chirurgie – générale
ADERDOUR Lahcen Oto- rhino- laryngologie FOURAIJI Karima Chirurgie pédiatrique B
ADMOU Brahim Immunologie GHANNANE Houssine Neurochirurgie
AIT BENALI Said Neurochirurgie KHALLOUKI Mohammed Anesthésie- réanimation
AIT-SAB Imane Pédiatrie KHATOURI Ali Cardiologie
AKHDARI Nadia Dermatologie KISSANI Najib Neurologie
AMAL Said Dermatologie KOULALI IDRISSI Khalid Traumato- orthopédie
AMINE Mohamed Epidémiologie- clinique KRATI Khadija Gastro- entérologie
AMMAR Haddou Oto-rhino-laryngologie LAOUAD Inass Néphrologie
ARSALANE Lamiae Microbiologie -Virologie LMEJJATI Mohamed Neurochirurgie
ASMOUKI Hamid Gynécologie- obstétrique B LOUZI Abdelouahed Chirurgie – générale
ASRI Fatima Psychiatrie MAHMAL Lahoucine Hématologie - clinique
BENELKHAIAT BENOMAR Ridouan Chirurgie - générale MANOUDI Fatiha Psychiatrie
BOUAITY Brahim Oto-rhino- laryngologie MANSOURI Nadia Stomatologie et chiru maxillo faciale
BOUGHALEM Mohamed Anesthésie - réanimation MOUDOUNI Said Mohammed
Urologie
BOUKHIRA Abderrahman Biochimie - chimie MOUTAJ Redouane Parasitologie
BOUMZEBRA Drissi Chirurgie Cardio-Vasculaire MOUTAOUAKIL Abdeljalil Ophtalmologie
BOURROUS Monir Pédiatrie A NAJEB Youssef Traumato- orthopédie
BOUSKRAOUI Mohammed Pédiatrie A NEJMI Hicham Anesthésie- réanimation
CHAKOUR Mohamed Hématologie NIAMANE Radouane Rhumatologie
CHELLAK Saliha Biochimie- chimie OULAD SAIAD Mohamed Chirurgie pédiatrique
CHERIF IDRISSI EL GANOUNI Najat
Radiologie RAJI Abdelaziz Oto-rhino-laryngologie
CHOULLI Mohamed Khaled Neuro pharmacologie SAIDI Halim Traumato- orthopédie
DAHAMI Zakaria Urologie SAMKAOUI Mohamed Abdenasser
Anesthésie- réanimation
EL ADIB Ahmed Rhassane Anesthésie- réanimation SARF Ismail Urologie
EL FEZZAZI Redouane Chirurgie pédiatrique SBIHI Mohamed Pédiatrie B
EL HATTAOUI Mustapha Cardiologie SOUMMANI Abderraouf Gynécologie- obstétrique A/B
EL HOUDZI Jamila Pédiatrie B TASSI Noura Maladies infectieuses
ELFIKRI Abdelghani Radiologie YOUNOUS Said Anesthésie- réanimation
ESSAADOUNI Lamiaa Médecine interne ZOUHAIR Said Microbiologie
ETTALBI Saloua Chirurgie réparatrice et plastique
Professeurs Agrégés
Nom et Prénom Spécialité Nom et Prénom Spécialité ABKARI Imad Traumato- orthopédie B FADILI Wafaa Néphrologie
ABOU EL HASSAN Taoufik Anésthésie- réanimation FAKHIR Bouchra Gynécologie- obstétrique A
ABOUCHADI Abdeljalil Stomatologie et chir maxillo faciale
FAKHRI Anass Histologie- embyologie cytogénétique
ABOUSSAIR Nisrine Génétique GHOUNDALE Omar Urologie
ADALI Imane Psychiatrie HACHIMI Abdelhamid Réanimation médicale
ADALI Nawal Neurologie HAJJI Ibtissam Ophtalmologie
AGHOUTANE El Mouhtadi Chirurgie pédiatrique A HAOUACH Khalil Hématologie biologique
AISSAOUI Younes Anesthésie - réanimation HAROU Karam Gynécologie- obstétrique B
AIT AMEUR Mustapha Hématologie Biologique HOCAR Ouafa Dermatologie
AIT BENKADDOUR Yassir Gynécologie- obstétrique A
JALAL Hicham Radiologie
ALAOUI Mustapha Chirurgie- vasculaire péripherique
KAMILI El Ouafi El Aouni Chirurgie pédiatrique B
ALJ Soumaya Radiologie KHOUCHANI Mouna Radiothérapie
AMRO Lamyae Pneumo- phtisiologie KRIET Mohamed Ophtalmologie
ANIBA Khalid Neurochirurgie LAGHMARI Mehdi Neurochirurgie
ATMANE El Mehdi Radiologie LAKMICHI Mohamed Amine Urologie
BAIZRI Hicham Endocrinologie et maladies métaboliques
LAKOUICHMI Mohammed Stomatologie et Chirurgie maxillo faciale
BASRAOUI Dounia Radiologie LOUHAB Nisrine Neurologie
BASSIR Ahlam Gynécologie- obstétrique A
MADHAR Si Mohamed Traumato- orthopédie A
BELBARAKA Rhizlane Oncologie médicale MAOULAININE Fadl mrabih rabou
Pédiatrie (Neonatologie)
BELKHOU Ahlam Rhumatologie MATRANE Aboubakr Médecine nucléaire
BEN DRISS Laila Cardiologie MEJDANE Abdelhadi Chirurgie Générale
BENCHAMKHA Yassine Chirurgie réparatrice et plastique
MOUAFFAK Youssef Anesthésie - réanimation
BENHIMA Mohamed Amine Traumatologie - orthopédie B
MOUFID Kamal Urologie
BENJELLOUN HARZIMI Amine Pneumo- phtisiologie MSOUGGAR Yassine Chirurgie thoracique
BENJILALI Laila Médecine interne NARJISS Youssef Chirurgie générale
BENLAI Abdeslam Psychiatrie NOURI Hassan Oto rhino laryngologie
BENZAROUEL Dounia Cardiologie OUALI IDRISSI Mariem Radiologie
BOUCHENTOUF Rachid Pneumo- phtisiologie OUBAHA Sofia Physiologie
BOUKHANNI Lahcen Gynécologie- obstétrique B
QACIF Hassan Médecine interne
BOURRAHOUAT Aicha Pédiatrie B QAMOUSS Youssef Anésthésie- réanimation
BSISS Mohamed Aziz Biophysique RABBANI Khalid Chirurgie générale
CHAFIK Rachid Traumato- orthopédie A
RADA Noureddine Pédiatrie A
DAROUASSI Youssef Oto-Rhino - Laryngologie RAFIK Redda Neurologie
DRAISS Ghizlane Pédiatrie RAIS Hanane Anatomie pathologique
EL AMRANI Moulay Driss Anatomie RBAIBI Aziz Cardiologie
EL ANSARI Nawal Endocrinologie et
maladies métaboliques ROCHDI Youssef Oto-rhino- laryngologie
EL BARNI Rachid Chirurgie- générale SAJIAI Hafsa Pneumo- phtisiologie
EL BOUCHTI Imane Rhumatologie SAMLANI Zouhour Gastro- entérologie
EL BOUIHI Mohamed Stomatologie et chir maxillo faciale
SEDDIKI Rachid Anesthésie - Réanimation
EL HAOUATI Rachid Chiru Cardio vasculaire SORAA Nabila Microbiologie - virologie
EL HAOURY Hanane Traumato- orthopédie A TAZI Mohamed Illias Hématologie- clinique
EL IDRISSI SLITINE Nadia Pédiatrie ZAHLANE Kawtar Microbiologie - virologie
EL KARIMI Saloua Cardiologie ZAHLANE Mouna Médecine interne
EL KHADER Ahmed Chirurgie générale ZAOUI Sanaa Pharmacologie
EL KHAYARI Mina Réanimation médicale ZEMRAOUI Nadir Néphrologie
EL MGHARI TABIB Ghizlane Endocrinologie et maladies métaboliques
ZIADI Amra Anesthésie - réanimation
EL OMRANI Abdelhamid Radiothérapie ZYANI Mohammed Médecine interne
Professeurs Assistants
Nom et Prénom Spécialité Nom et Prénom Spécialité ABDELFETTAH Youness Rééducation et Réhabilitation
Fonctionnelle Hammoune Nabil Radiologie
ABDOU Abdessamad Chiru Cardio vasculaire HAZMIRI Fatima Ezzahra Histologie – Embryologie - Cytogénéque
ABIR Badreddine Stomatologie et Chirurgie maxillo faciale
IHBIBANE fatima Maladies Infectieuses
ADARMOUCH Latifa Médecine Communautaire (médecine préventive, santé publique et hygiène)
JALLAL Hamid Cardiologie
AIT BATAHAR Salma Pneumo- phtisiologie JANAH Hicham Pneumo- phtisiologie
AKKA Rachid Gastro - entérologie KADDOURI Said Médecine interne
ALAOUI Hassan Anesthésie - Réanimation LAFFINTI Mahmoud Amine Psychiatrie
AMINE Abdellah Cardiologie LAHKIM Mohammed Chirurgie générale
ARABI Hafid Médecine physique et réadaptation fonctionnelle
LALYA Issam Radiothérapie
ARSALANE Adil Chirurgie Thoracique LOQMAN Souad Microbiologie et toxicologie environnementale
ASSERRAJI Mohammed Néphrologie MAHFOUD Tarik Oncologie médicale
BAALLAL Hassan Neurochirurgie MARGAD Omar Traumatologie -orthopédie
BABA Hicham Chirurgie générale MILOUDI Mohcine Microbiologie - Virologie
BELARBI Marouane Néphrologie MLIHA TOUATI Mohammed Oto-Rhino - Laryngologie
BELBACHIR Anass Anatomie- pathologique MOUHSINE Abdelilah Radiologie
BELFQUIH Hatim Neurochirurgie MOUNACH Aziza Rhumatologie
BELHADJ Ayoub Anesthésie -Réanimation MOUZARI Yassine Ophtalmologie
BENNAOUI Fatiha Pédiatrie (Neonatologie) NADER Youssef Traumatologie - orthopédie
BOUCHAMA Rachid Chirurgie générale NADOUR Karim Oto-Rhino - Laryngologie
BOUCHENTOUF Sidi Mohammed
Chirurgie générale NAOUI Hafida Parasitologie Mycologie
BOUKHRIS Jalal Traumatologie - orthopédie NASSIM SABAH Taoufik Chirurgie Réparatrice et Plastique
BOUZERDA Abdelmajid Cardiologie NYA Fouad Chirurgie Cardio - Vasculaire
CHETOUI Abdelkhalek Cardiologie OUERIAGLI NABIH Fadoua Psychiatrie
CHRAA Mohamed Physiologie REBAHI Houssam Anesthésie - Réanimation
EL HARRECH Youness Urologie RHARRASSI Isam Anatomie-patologique
EL KAMOUNI Youssef Microbiologie Virologie SALAMA Tarik Chirurgie pédiatrique
EL MEZOUARI El Moustafa Parasitologie Mycologie SAOUAB Rachida Radiologie
ELBAZ Meriem Pédiatrie SEBBANI Majda Médecine Communautaire (médecine préventive, santé publique et hygiène)
ELQATNI Mohamed Médecine interne SERGHINI Issam Anesthésie - Réanimation
ESSADI Ismail Oncologie Médicale TAMZAOURTE Mouna Gastro - entérologie
FDIL Naima Chimie de Coordination Bio-organique
TOURABI Khalid Chirurgie réparatrice et plastique
FENNANE Hicham Chirurgie Thoracique YASSIR Zakaria Pneumo- phtisiologie
GHAZI Mirieme Rhumatologie ZARROUKI Youssef Anesthésie - Réanimation
GHOZLANI Imad Rhumatologie ZIDANE Moulay Abdelfettah Chirurgie Thoracique
HAMMI Salah Eddine Médecine interne ZOUIZRA Zahira Chirurgie Cardio-Vasculaire
LISTE ARRÉTÉÉ LE 12/02/2018
To my dear mother Fatiha It is not a lie when they say all the words in the world can’t express the infinite love that I carry for you. You have been my sunshine, my guidance and my source of tenderness. You are the embodiment of the warrior mother who protects and provides for her children at all costs. Your integrity and courage, at time of difficulty, will always be an example to follow. And I love, love, love you. May Allah Almighty, preserve and grant your health, long life and happiness. To my dear father M'Hammed You have always inspired the way forward, your love and dedication to your medical profession, guided us. It is through your encouragement that I opted for this noble profession. I hope I have answered the hopes you have built in me. You are my moral support and my source of joy and happiness, may God keep you and give you good health. In memory of my grandparents It is with a lot of nostalgia, that I remember the beautiful memories and the unforgettable moments spent together. Your warm welcome and your great kindness have greatly affected me. I wish you were here so that I could express my gratitude to you. May God take you into his mercy. To my sisters Lamiaa and Hasnae We lived together, shared everything, received the same education, followed the same path. I would like to express to you through these lines all my feelings of love, may our sisterhood unite us forever. I wish you every success in your medical studies and fill you with happiness throughout your life.
To my little brother Ismail Your extreme kindness has forced the love and admiration of everyone. It is with great love that I greet you, and wish you every success in your studies. To my aunts Bahija, Amal, Saida My uncles Abdelali, Abdellatif, Abdelkhalek, Mohammed Please accept the expression of my deep gratitude for your support, encouragement, and affection. I hope you find in the dedication of this work, the testimony of my sincere feelings and my wishes for health and happiness. To the Khaoua Family May this work be the testimony of my great love and esteem. God preserve you and give you long life and good health. To all my family members, big and small Please find in this modest work the expression of my affection. To my friend and sister Mouna Cousins by blood, sisters by heart, friends by choice Your kindness, your generosity and your help have been for me a source of courage, as well as your valuable advice has given me confidence in my abilities. Our memories and past events together will be engraved forever in my memory. May Almighty God fill you with happiness and bring you success in your private and professional life.
To my friends Hajar, Soukaina and Nada I may have crossed paths with each one of you at a different stage of my life, but time isn’t what defines these kind of friendships. Through thick and thin, through hardships and joys and one laugh at a time, I will always cherish our time spent together and hope God keeps you by my side in the years to come. May your life be as successful and joyful as you deserve it to be. To my friend Hajar, I will always admire the integrity with which you carry yourself. I am truly proud to call you my friend. To my nightshift and clerkship partners and friends Amal, Zineb, Fatime-ezzahra, Lamya, Ghizlane, Kenza, Omar, Moncef, Koussay, YassineAdil, Redouane, Fahd, Abdelghafour, Reda and Najib. Our friendship transcended the hospital wards and continued to bring me support and joy in life outside the hospital. I will forever cherish the moments spent together. May I see you all shine in your career and in your personal lives. To all medical and paramedical staff of the the C.H.U. Marrakech I express my sincere gratitude and great gratitude to you. Thank you To all who participated in my training Thank you and God bless you To all the staff of the Faculty of Medicine of Marrakech The staff of the library of the Faculty of Medicine of Marrakech May they find here the expression of my sincere thanks.
Acknowledgments
To our Master and thesis president, Professor Abderraouf SOUMMANI,
Professor of Gynaecology and Obstetrics. Thank you for the honour you have done us by accepting to chair in this jury.
Your seriousness, your competence and sense of duty have greatly impressed us. Please find there the expression of our respectful consideration and deep admiration
for all of your scientific and human qualities. This work is an opportunity for us to express our deep gratitude.
To our Master and Thesis supervisor, Professor Karam HAROU. You have entrusted us this rich work of interest and guided us every step of its
implementation. You always reserved for us the best reception, despite your professional obligations.Your tireless encouragement and your kindness deserve all
of admiration.We take this opportunity to express our deep gratitude while witnessing you our respect.
To our Master and thesis judge, Professor ASMOUKI, Professor in gynaecology.
Thank you for your valuable participation in the development of this work. Allow us to express our admiration for your human and professional qualities.
Please find here the expression of our esteem and consideration.
To our Master, Professor Redouane EL FEZZAZI, Professor in Paediatric surgery.
You have honoured us with the great sympathy to sit among our thesis jury. Please find here the expression of our respects and our acknowledgments.
To our Master, Professor Mohamed AMINE, Professor in clinical epidemiology and research.
You have honoured us with the great sympathy to sit among our thesis jury. Please find here the expression of our respects and our acknowledgments.
To our Master, Professor Majda Sebbani, Professor in clinical epidemiology and research.
Thank you for your valuable participation and help in the development of this work, Allow us to express our admiration for your human and professional qualities.
Please find here the expression of our esteem and consideration.
To our Master, professor Ghassane EL ADIB, Thank you for your valuable participation in our work,
Please find here the expression of our esteem and consideration.
To our Master, professor Ghizlane RAISS Thank you for your valuable participation in our work,
Please find here the expression of our esteem and consideration.
To our Master, professor Lahcen BOUKHANNI Thank you for your valuable participation in our work,
Please find here the expression of our esteem and consideration.
To our Headmaster and Dean of the Medical school, Professor Mohammed BOUSKRAOUI,
Professor in Pediatrics, With this work, I would like to express my utmost consideration, admiration and my sincere thanks. For this work would not have been possible without your dedication
to improve our school educational system and strive to achieve higher level of education’s quality
Abbreviations
List of abbreviations
FMPM : Faculty of Medicine and Pharmacy of Marrakech OSCE : Objective Structured Clinical Examination SP : Standardized patient CBME : Competency-Based Medical Education PSS : Perceived Stress Scale TCE : Traditional Clinical Examination ECG : Electrocardiogram REMPO : Réformes des études médicales, pharmaceutiques et odontologiques LMD : License-Master-Doctorate TIPS : Test of Integrated Professional Skills
Table of contents
INTRODUCTION…………………………………………………………………1 METHOD AND PARTICIPANTS………………………………………………..4 I. Participants…………………………………………………………………………………5
1. Type of study……………………………………………………………………………………………….5 2. Setting of study…………………………………………………………………………………………….5 3. Duration of study…………………………………………………………………………………………..5 4. Subjects of the study………………………………………………………………………………………5
II. Method………………………………………………………………………………………6 1. Questionnaire……………………………………………………………………………………………….6 2. Data collection………………………………………………………………………………………………7 3. Statistical analysis………………………………………………………………………………………….7 4. Study limits…………………………………………………………………………………………………..8 5. Ethical consideration……………………………………………………………………………………….8 6. Collected Variables…………………………………………………………………………………………8
RESULTS…………………………………………………………………………..9 I. Students profile……………………………………………………………………………10
1. Year of study……………………………………………………………………………………………….10 2. Student status……………………………………………………………………………………………...10
II. Perception and feedback…………………………………………………………………11 1. OSCE attributes…………………………………………………………………………………………….11 2. Preparation for the OSCE………………………………………………………………………………..14 3. OSCE set-up and organization…………………………………………………………………………16 4. Content of osce……………………………………………………………………………………………18
DISCUSSION……………………………………………………………………..21 I. Reminder…………………………………………………………………………………….22
1. A brief history of the OSCE………………………………………………………………………………22 2. Definition of the OSCE…………………………………………………………………………………….23 3. Development of an OSCE program……………………………………………………………………..24 4. Preparation and Organization of the OSCE……………………………………………………………29 5. Design of an OSCE station………………………………………………………………………………..34
II. Discussion of results………………………………………………………………………38 1. Perception of the students of the OSCE………………………………………………………………..38 2. Limits and strengths of the OSCE………………………………………………………………………..44 3. Suggestions for improvement of the OSCE ……………………………………………………………46
CONCLUSION ABSTRACT APPENDICES BIBLIOGRAPHY
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
1
Introduction
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
2
By the end of their medical curriculum, medical students have to take one more final exam
to evaluate their acquired medical knowledge and competencies. For many years now, the method
of choice was the traditional clinical examination. However, this method which generally evaluates
a single clinical case remains subjective and not reproducible from one candidate to another.
Given the central role of the assessment of the teaching-learning dynamics, it is
fundamentally important to be concerned about the consistency of the evaluation process along
with the conceptual orientations of the training program.
It was therefore imperative to look for a new evaluation method, and in this context, the
Structured Objective Clinical Examination (OSCE) presented itself as the instrument closest to the
ideal assessment of competence meeting the criteria of objectivity, reproducibility and multi-
dimensionality.
The OSCE is a formative and summative evaluation tool deemed relevant for its reliability
and validity during the clinical evaluation.
Some of the goals of the OSCE are:
• To test the competencies developed during the medical clerkship
• To obtain a feedback from health professionals
• To develop a more active pedagogy
• To promote learning by skill
• To improve the educational coherence
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
3
Although the OSCE is considered the most effective instrument for evaluating clinical
competence worldwide [1
Our study aims to report the development and implementation of the OSCE as a first
experience by the pedagogical team of the Faculty of Medicine and Pharmacy of Marrakech, to
assess the overall perception and acceptance of the students regarding this new assessment tool
and to identify its strengths and weaknesses through their feedback.
], the experiment of this type of exam is still limited in Morocco.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
4
Material and Method
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
5
I.
1.
Participants:
Our work is a cross-sectional study asserting the preferences and perceptions of medical
students in their final years of clinical clerkship or internship who have participated in an OSCE in
gynecology & obstetrics.
Type of study:
2.
The study was conducted at the Faculty of Medicine of Marrakech, Morocco. The students
were asked to complete the survey in the pedagogical staff room after their completion of the
OSCE.
Setting of study:
3.
The study was conducted from December 2016 to February 2018 with a total of 6
sessions of OSCE.
Duration of study:
4.
This study includes all medical students in the final year of their curriculum who have taken
part of an OSCE in gynecology & obstetrics in the period of the study. There was no age or gender
restriction. A total of 360 students participated in the six sessions of OSCEs. A total of 253
students participated in our survey.
Participants of the study:
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
6
i.
a. Participated in an OSCE in gynecology and obstetrics in one of the sessions from
December 2016 to February 2018
Inclusion criteria:
b. Being part of an internship or a clerkship
c. Being in the 6th, 7th or 8th
ii.
grade
None
UFlow chart1; Number of students taking OSCE during our study period
UFlow chart 2: Students filling out the questionnaire U UFlow chart3: Paper VS. Online questionnaire
422 PARTICIPANTS OSCE SESSIONS
DECEMBER 2016 61 STUDENTS
FEBRUARY 2017 37 OF STUDENTS
MAY 2017 41 OF STUDENTS
OCTOBER 2017 184 OF STUDENTS
DECEMBER 2017 58 OF STUDENTS
FEBRUARY 2018 41 OF STUDENTS
422 PARTICIPANTS IN
OSCE
346 QUESTIONNAIRE
SENT
253 RECEIVED ANSWERS
346 SENT
QUESTIONNAIRE
223 ONLINE QUESTIONNAIRE
23 PAPER QUESTIONNAIRE
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
7
II. UMethod:
1. UQuestionnaire:
We used a validated questionnaire (see appendices) with various sections, modified from a
study by Pierre et al. (2004) [ P1F
2P].
The questionnaire is comprised of 4 sections and 22 questions to evaluate the students’
perceptions of the nature, content, structure and organization of the OSCE; quality of performance
and objectivity of the OSCE process; and perceptions of OSCE validity and reliability. The
questionnaire was created using Google forms.
• USection 1:
This section assesses medical students’ evaluation of the OSCE attributes, and it includes 6
items such as the fairness of the exam, level of stress, exam maximizes chances of passing and
exam being intimidating.
• USection 2:
This section reports students’ level of preparation of the exam with items such as being
well informed of the nature of the exam, of the level of knowledge needed to pass the exam,
difficulty to prepare for the exam.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
8
•
Exclusion criteria:
This section discusses the organization of the exam with items about the number of
stations, the time allocated to each stations, the organization, the instructions and the realness of
stations with SPs.
• USection 4:
This section discusses the content of the examination with items about the knowledge
covered by the evaluation, the clinical skills reflecting the ones taught and being the ones needed
for a general practice.
A psychometric five-level Likert scale that indicates degrees of agreement was used to
assess most of the dimensions in the questionnaire, where Strongly Agree (SA)=5, Agree (A)=4,
Neutral (N)=3, Disagree (D)=2, Strongly Disagree (SD)=1.
A Perceived Stress Scale (PSS) was used to measure the stress level of students during the
exam. A ten-item PSS was used with 1 being very low level of stress and 10 being very high level
of stress.
2. UData collection:
The questionnaire was self-administered with online questionnaires and paper
questionnaires.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
9
The online questionnaire was sent to the students via Facebook and collected with Google
Forms and the paper questionnaire was handed out to some students immediately after
completing the OSCE circuit and before leaving the examination venue.
Section 3:
The students were quickly briefed about the objectives of the survey. They were also
informed that the responses they provide would remain confidential and their identity would not
be disclosed, and if they chose not to participate; they would not be pressured to do so.
3.
• Attributes of OSCE
Collected variables:
• Preparation for OSCE
• Organization of OSCE
• Content of OSCE
4.
Data collection was carried out with Google forms and transferred for analysis to
Microsoft Office Excel 2007 using SPSS‑16 version. The analysis was conducted at the department
of clinical epidemiology and statistics with the help of Pr. Majda Sebbani. The analysis was
descriptive. The quantitative variables were expressed as frequencies and percentages. The
comparison between the two subgroups was done using the Fisher exact test with a statistically
significant threshold (P)=5%. Basic statistical analysis of the Likert items was conducted by
calculating frequencies and percentages.
Statistical analysis:
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
10
5.
The study was limited due to:
Study limits:
• Inappropriately filled questionnaire
• Unwillingness to fill out the questionnaire
• Answers may be altered because of lack of memory on the subject, or even boredom
• Answers may be altered by the stress of the exam
• Examiners feedback was not evaluated
6.
The permission required to conduct the study was obtained from the ethical committee of
the Faculty of Medicine of Marrakech after explaining the purpose of the study. The students’
approval was obtained by explaining the significance of the study to them and assuring their
confidentiality of data collection.
Ethical consideration:
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
11
Results
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
12
I. a.
Students Profile:
Year of study:
In our study group, out of the 242 participants, the majority were in their 8th year representing 79% and 21% were in their 7th
year.
Figure1: Year of study
b. Students status:
The majority of our study group was enrolled in a clerkship representing 76%, while 24%
was enrolled in an internship.
Figure2: Students’ status
7th Year 21%
8th Year 79%
76%
24% Clerkship
Internship
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
13
II. a.
Perception and feedback:
i. OSCE attributes:
More than half of our study group (52%) felt that the exam was fair, while (26%) viewed the exam as unfair.
Exam’s fairness:
Figure3: Student’s view on exam’s fairness
ii.
The level of stress of the students varied, with (24, 2%) feeling a level 8 of stress. Exam’s level of stress:
Figure4: Student’s level of stress during the exam
16%
36% 24%
16% 8%
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
2,1 2,1 5,1 6,4
14,8 16,1 14,8
24,2
6,4 8,1
1 2 3 4 5 6 7 8 9 10
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
14
iii.
In our study, (83%) of students felt that the OSCE increased chances of passing while only (4%) disagreed. The remaining (13%) neither agreed nor disagreed.
Exam increases chances of passing:
Figure5: Exam increases chances of passing
iv. (40%) of the participants felt the exam to be intimidating while (37%) felt that it wasn’t.
Exam is intimidating:
Figure6: Exam is intimidating
31%
52%
13%
2% 2%
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
8%
32%
23%
30%
7% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
15
v. In our study group, (71,2%)) of the participants felt that the OSCE are less stressful
than the TCE. We found similar results for the sub-groups who experienced both type of examination.
Preference between TCE and OSCE:
Figure7: Perception of stress comparing TCE and OSCE for students who only experienced OSCE
Figure7 bis: Perception of stress comparing TCE and OSCE for students who experienced both TCE and OSE
71,2
28,8
0
10
20
30
40
50
60
70
80
OSCE less stressful than TCE OSCE more stressful than TCE
Only OSCE
76,9
23,1
0
10
20
30
40
50
60
70
80
90
OSCE less stressful than TCE OSCE more stressful than TCE
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
16
(91, 3%) of the participants were more favorable to the OSCE and only (8, 7%) were more in favor of the TCE.
Figure8: Preference of students between OSCE and TCE
b. i.
Preparation for the exam:
In our study group, an average of (55%) of the participants felt that they were fully aware of the nature of the exam, while an average of (27%) felt the opposite. (18%) were neutral.
Awareness of nature of exam:
Figure9: Student’s awareness of the nature of the exam
91,3
8,7
More favorable to OSCE
More favorable to TCE
16%
39% 18%
21%
6% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
17
ii.
(44%) of the participants felt they were not fully aware of the level of knowledge needed to pass the OSCE, while only (36%) felt that they were aware enough.
Awareness of level of knowledge needed:
Figure10: Student’s awareness of level of knowledge needed for the exam
iii.
In our study group, the majority of the students felt that the OSCE provided them with an opportunity to learn some competencies in a better way, with (58%) strongly agreeing, (24%) agreeing, and only (9%) disagreeing.
Exam provided opportunities to learn:
Figure11: Student’s perception of exam providing opportunity a better way to learn some
competencies
10%
26%
20%
35%
9% Strongly Agree
Agree
Neither Agrre nor Disagree
Disagree
Strongly Disagree
24%
58%
9% 6%
3% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
18
iv. In our study, (58, 2%) of the respondents found it difficult to prepare for the exam and
Difficulty to prepare for exam:
(19, 8%) felt the opposite.
Figure12:
Difficulty to prepare for the exam
c. i.
OSCE organization and set-up:
Approximately (68%) of the participants felt that the OSCE was well organized, while (18%) felt it wasn’t.
Organization of the OSCE:
Figure13: Student’s opinion about the organization of the OSCE
12,8
45,4
21,9
15,7
4,1
0
5
10
15
20
25
30
35
40
45
50
Strongly Agree Agree Neither Agree nor Disagree
Disagree Strongly Disagree
18%
50%
14%
15%
3% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
19
ii.
Over half of the examinees (52%) felt that the number of stations was adequate and (28%) feeling it was not.
Number of stations:
Figure14: Student’s opinion about the number of stations
iii. In our study, (45%) felt that the time allocated to each station was not enough, while just
(41%) felt the opposite.
Time allocated for each station:
Figure15: Student’s opinion about time allocated to each station
10%
42%
20%
23%
5% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
13%
28%
14%
32%
13% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
20
iv. We had (43,8%) of the participants who felt that that the instructions weren’t clear and were
ambiguous.
Instructions were clear and non-ambiguous:
Figure16: Student’s opinion about the instructions at the stations
v. Over half of the examinees (52%) felt that the stations with SPs were close to real life
scenarios, with only (29%) disagreeing.
SPs stations were simulating real life scenarios:
Figure17: Student’s opinion about the stations with SPs
7,4
28,1
20,7
36,4
7,4
Strongly Agree Agree Neither Agree nor Disagree
Disagree Strongly Disagree
8%
44% 19%
25% 4%
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
21
d. i.
Content of OSCE:
(73%) of the students felt that the OSCE covered a wide area of competencies. Exam covers a wide area of competencies:
Figure18: Exam covers a wide area of competencies
ii. Out of 242 participants, (45%) felt that the clinical competencies evaluated didn’t reflect
those taught, while only (33%) felt the opposite.
Clinical competencies evaluated reflected those taught:
Figure19: Clinical competencies reflected those taught
20%
53%
17%
7%
3% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
7%
26%
22%
34%
11% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
22
i. Over half of the students (51%) felt that the competencies evaluated during the OSCE were
the ones needed for a general practitioner.
Clinical competencies evaluated reflected those needed for general practice:
Figure20: Clinical competencies evaluated reflected those needed for a general doctor
15%
36%
16%
26%
7% Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
23
Table I: Medical undergraduates’ students’ evaluation of OSCE attributes
Survey Items
Degree of response
Agree ((%) Neutral (%) Disagree (%)
Exam was fair 52% 24% 24%
Exam was intimidating 40% 23% 37%
Exam minimized chance of failing 83% 13% 4%
OSCE is less stressful than other exams 71,2% 0% 28,8%
Awareness of the nature of the exam 55% 18% 27%
Awareness of level of knowledge needed 36% 20% 44%
Exam provided opportunities to learn 82% 9% 9%
Difficulty to prepare for the exam 58,2% 21,9% 19,8%
Exam was well organized, structured and sequenced 68% 14% 18%
Adequate number of stations 52% 20% 28%
Time at each station was adequate 45% 14% 41%
Instructions were clear and unambiguous 35,5% 20,7% 43,8%
SPs stations felt authentic 52% 19% 29%
Wide area of knowledge covered 73% 17% 10%
Tasks reflected skills taught 33% 22% 45%
Tasks reflected skills required for a general practitioner 51% 16% 33%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
24
Discussion
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
25
I.
1.
Reminder:
While deficiencies in the conventional or traditional clinical examinations have been
clearly identified [
A brief history of the OSCE:
3,4], few attempts have been made to improve the assessment of a student’s
clinical skills. The need for a more objective approach to the assessment of clinical competence
has been widely advocated [5,6
In long and short case examinations:
].
• The candidate was assigned a patient in a clinical setting that involved varying levels
of simulations
• The candidate was given time to take the patient’s history and do a physical
examination
• A board of examiners interviewed the candidate afterward, asking about the case
• The candidate was not observed in the patient interaction
• Each candidate had an entirely unique (inconsistent) examination experience7
In this context, Harden described for the first time in 1975 [
8], what was later considered
the “gold Standard” [9] for evaluating clinical competence, the Objective Structured Clinical
Examination or OSCE, which avoids many of the disadvantages of the more conventional methods
of assessing clinical competence.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
26
The OSCE is now used in countries around the world to assess clinical competence in a
range of disciplines, in different health care professions such as medicine, nursing [10],
dentistry[11] physiotherapy [12] and pharmacy [13
1
] and in the different phases of education. It has
also been used outside medicine, for example in the police force [ ]. A study from Hardem et al.
[14
2.
] showed that 239 universities, institutions or organizations use or have used the OSCE, and
that the three countries who have published most articles on the OSCE were the USA, Canada and
the UK.
The objective structured clinical examination, or the OSCE for short, is an approach to the
assessment of clinical competence in which the components of competence are assessed in a
planned way with attention being paid to the objectivity of the examination [
Definition of the OSCE:
15
The clinical competence to be tested is broken down into its various components, for
example, taking a history of a patient, auscultation of the heart, interpretation of an ECG or
coming to a conclusion on the basis of the findings. Each component is assessed in turn and is the
objective of one the stations of the examination [
].
16
This examination includes a circuit of stations each candidate is examined with one or two
examiners. Some stations use SPs or real patients. At each station, there is one or two examiners,
as opposed to the traditional method of clinical examinations where a candidate is assigned to a
jury for the whole exam. All candidates perform the same stations. The stations are standardized,
allowing the comparison between the candidates.
].
This exam was designed to be:
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
27
• Objective: all candidates are evaluated using exactly the same stations (although
there might be some slight variations due to SPs or actual patients) with the same grid and
scoring. Noting each candidate with the same scale when they perform each of the station's tasks
correctly makes the assessment more objective.
• Structured: Each station of the exam has a very specific task. When SPs are used,
detailed scripts are provided to ensure that the information they give to the candidates is the
same, including the emotions that the patient express during the consultation. The instructions
are carefully written to ensure that the candidate identifies that he has a specific task to complete.
The exam is carefully structured to include parts of all curriculum elements as well as a wide range
of skills.
• Clinical: The OSCE is designed to apply theoretical and clinical knowledge to
simulated situations. Theoretical questions may be asked by the examiner at the end of each
station. These questions are standardized and the candidate is questioned only if the questions
are on the exam sheet for the station.
• Examination: An OSCE enables a reliable assessment of a candidate’s competence.
OSCEs are suitable for use in high-stakes assessments. OSCEs are now used widely in
undergraduate, postgraduate and licensing assessments.
3.
In Morocco, a project for the reform of medical, pharmaceutical and odonatological
studies (REMPO) was launched in 2005. The aim of this reform was to link our medical education
system in the international sphere by registering it in the License (Bachelor)-Master-Doctorate
Development of an OSCE program:
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
28
(LMD) System. In addition to this, the reform came as an answer to the changing needs in society,
the changing nature of healthcare, the need to train a new general practitioner profile that apply
the principles of health promotion based on the disease trends of the population and apply public
health strategies [17
The current medical education system is based on a curriculum that is subject-centred and
time-based. Most evaluations are summative, with little opportunity for feedback. The teaching–
learning activities and the assessment methods focus more on knowledge than on attitude and
skills. Thus, graduates may have extraordinary knowledge, but may lack the basic clinical skills
required in practice. In addition, they may also lack the soft skills related to communication,
doctor–patient relationship, ethics, and professionalism.
].
Competency-based medical education (CBME) has been suggested and tried to tackle these
concerns. Competency is defined as “the ability to do something successfully and efficiently,” [18]
and CBME is an approach to ensure that the graduates develop the competencies required to fulfil
the patients’ needs in the society. It de-emphasizes time-based training and promises greater
accountability, flexibility, and learner-centeredness [19]. This means that teaching–learning and
assessment would focus on the development of competencies and would continue till the desired
competency is achieved. The training would continue not for a fixed duration, but till the time the
standard of desired competency is attained. Assessments would be frequent and formative in
nature, and feedback would be inbuilt in the process of training. Furthermore, each student would
be assessed by a measurable standard which is objective and independent of the performance of
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
29
other students. Thus, it is an approach in which the focus of teaching–learning and assessment is
on real-life medical practice. [20
Since CBME is learner-centred, offers flexibility in time, and focuses on all the three
domains of learning together (cognitive, affective and psychomotor); the teaching–learning
activities would need a change in structure and process. Since it focuses on outcomes and
prepares students for actual professional practice, teaching–learning activities would be more
skill-based, involving more clinical, hands-on experience.
]
As CBME promises greater accountability, the assessment needs to be robust and
multifaceted. It should also answers to Miller’s pyramid of assessment [21
].
Figure21 : Miller’s pyramid of Assessment
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
30
Since naming him Dean of the Faculty of Medicine and Pharmacy of Marrakech,
Pr. Mohamed Bouskraoui, has been working on applying the objective of the medical education
reform. One of his main concerns was the students’ learning and evaluation experience.
In his desire to improve the quality of evaluation techniques and to be abridged of current
instructional technologies in medical education [22
Implementing the OSCE program required considerable financial resource and faculty time
and effort. As a first step, the faculty organized multiple seminars and workshops aimed at
training teachers by inviting speakers specialized in medical pedagogy from countries such as
Canada and the UK. The training lasted over one year.
], he took a pioneering role and introduced the
OSCE during the 2016-2017 academic sessions.
Figure22: OSCE workshop at the pedagogy department
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
31
An OSCE committee was then created to chaperon upcoming exams. Its main objectives
were to organize the OSCE circuits, design stations, choose questions and design instructions to
candidates, design performance and assessment instruments such as marking schemes and grids,
and finally recruit and train simulated patients.
An OSCE team is also required during the exam for correct movement of candidates and
accurate time keeping.
As a second step, a mock session was organized to get both teachers and students
acquainted to this new method. Students were actively invited to enroll in this experimental
session. The grade obtained in this session were not counted in the total student’s grades.
After the pilot session, the OSCE was officially implemented as the final year medicine
clerkship exam.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
32
Figure23: A OSCE mock session
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
33
4.
The organization of the OSCE requires considerable financial resource and faculty time and
effort. It could be divided into three separate steps.
Preparation and organization of the OSCE:
i.
An evaluation committee composed of exam officers was appointed. This committee
determined:
First step:
• The skills to be evaluated
• The number of stations required for the exam, as well as their characteristics
according to the clinical skills selected.
• The calendar of events which must include the dates of the informative sessions to
the students, to the evaluators and the schedule of the meetings for the final rating.
• The designation of the managers of each station.
An OSCE coordinator is designated as well and its principal roles are to:
• Prepare the venue of the examination with the help of the faculty’s staff.
• Supervise the confidentiality of the print media.
• Send reminders to the teachers.
• Make a report to the Vice Dean of educational affairs. The latter sends convocations
for the examination.
Frequent meetings are organized a month ahead of the exams at the Center for the Medical
Pedagogy of the Faculty of Medicine and Pharmacy of Marrakech.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
34
Figure24: Center for Simulation and Innovation in Health Sciences (CSISS) of the Faculty of Medicine and Pharmacy of Marrakech.
Figure25: OSCE committee preparation meeting
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
35
ii.
It consists of preparation of the examination venue and to chaperon the progress of the
examination. All persons involved in the examinations are required to report to the examination
site in advance.
Second step:
• Pedagogical and administrative staff: One hour before
• Students: 30 minutes before
• Teachers: 20 minutes before
• SPs: 15 minutes before
Enough space is required for circuit running and to accommodate the various stations,
equipment and materials for the exam. It should be able to accommodate an examiner, a student
and possibly the SP and also allow for enough privacy of discussion so that the students
performing other tasks are not distracted or disrupted. The faculty opted for two venues on two
separate levels with four rooms each, which allowed for two groups to pass the exam
simultaneously. Each room could fit up to four stations if needed.
Figure26 : Examination venue
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
36
The number of each station and the direction to the next one was clearly marked so not to
confuse the student. In addition, a coordinator stands in between the rooms to guide the students
to the next station.
Figure27: Directions and number of stations
Multiple circuit settings are available for the OSCE (See Appendices). We opted for a U-
shaped layout with an opening in the middle of the rooms. This allowed students to move
smoothly between stations. They were then equipped, according to the necessity of the stations,
with patient beds and examination tables, diagnostic instruments and digital audio-visual
monitoring system.
Figure28: U-shaped setting of stations
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
37
Upon arriving at the examination venue, the students are quickly briefed about the OSCE in
separate lecture halls by the OSCE marshal, Pr. El Fezzazi.
Since the number of candidates varies from a session to another, the number of stations
varies as well, depending on the number of students enrolled. The first two groups are called upon
and each group is guided to their correspondent venue. The student, rotates round a number of
stations, usually about 6, spending a speci n. The time allowed is the same for all the stations
which is usually about 5 minutes. An additional 30 seconds was allowed for the examiner to
finalize the marking scheme and for the student to move to the next station. This is done until
every candidate has visited each station. A rest fied time at each station. On a bell signal, the
student moves on to the next station and so o station is placed if there is considerable distance
between two stations.
Figure29: Coordination committee station
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
38
iii.
The third and final step consists of deliberations and validation of final marks. It is done on
the same day right after the examination. The teachers agree on the number of stations required
to pass the exam. The Vice Dean of educational affairs, the OSCE coordinator and the coordinator
of the specialty moderate the deliberation session.
Third step:
The verification of the number of validated stations as well as the grade is discussed for
each student. At the end of the deliberations, the grades are announced on the same day.
5.
i.
Design of an OSCE station:
There are different classifications of OSCE and many type of stations. We follow this
classification:
Type of stations:
• Anamnesis stations: the student is required to gather history of patient.
• Dry stations: the student is required to interpret laboratory tests or medical imagery
such as a mammography and conclude to a diagnosis. This station could require some material
such as audio-video system, pictures or x-rays.
• Manikin stations: or procedural stations; the student is required to accomplish a
medical procedure such as perform a breast or pelvic examination, a pap smear or a baby delivery.
• Communication skills stations: the student is required to demonstrate his
communication skills through tasks such as announcement of a cancer diagnosis, explication of a
treatment and the medical management to a patient or therapeutic education.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
39
Figure30: Anamnesis station, with the examinee, the SP, the evaluator and the head of the station
Figure31: Dry station with the examinee, the examiner and the head of the station
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
40
Figure32: Procedural station; here we have a student performing a pap smear.
Figure33: Student performing a breast examination on a manikin
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
41
Figure34: Dry station; interpretation of a mammography
ii.
• Choose the topic of the station and its aim
Guidelines for writing a station:
• Choose the station writers
• Identify the skills to be assessed
• Choose the station type based on the evaluated skills to be assessed
• Follow a station template for the type of station chosen
• Establish the instructions for the stations (see appendices)
• Establish the instructions for SPs and prepare the scenarios to follow
• Establish the marking grid and schemes (see appendices)
• Prepare a checklist for the station: material, room setting requirement23 (see
appendices)
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
42
II.
1.
Discussion of the results:
Understanding the perspective of students especially in the case of implementation of new
methods of evaluation is particularly important and valuable. Similarly, to other studies of
student’s perception of OSCE [
Student’s perception of OSCE:
24,25,26
Students’ evaluation of OSCE in this study was encouraging. This was demonstrated by the
favourable responses concerning its accuracy in measuring knowledge and skill, fairness of the
examination process, additional experience, and learning from the OSCE and its enhancement of
communication skills. These modest levels of acceptance of the OSCE by students have been
described in previous studies
] we tried to acknowledge different aspects of students’
perception of this method of examination. Questions in the survey concerned both the general
attributes of the exam (fairness, difficulty, equality, etc…) and the organization factors (including
the amount of time at stations, quality of instructions, etc…).
[27,28,29
i.
].
In our study, (52%) of the students believed that the exam was fair. Even though more than
half the students agree on the exam’s fairness, our exam did not score very high compared to
other reports
General attributes of OSCE:
[2, 13,30-33].
(See Table.II)
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
43
Table II: Exam’s fairness compared to other studies
The observation that the OSCE is much more intimidating (40%) than other written
examination methods, is consistent with other studies [2,13,33,34,35]. (See Table.III)
Table III: Exam being intimidating compared to other studies
A possible explanation is that a written examination is undertaken in relatively anonymity,
whereas the constant monitoring and observation during an OSCE may increase anxiety levels.
Also, in a written examination, there is no time limit for each question and students can spend
their time on any question, and if they do not know the answer to one question, they can think
about it at the end of the exam. However, during an OSCE, usually each station has its own time,
Authors Agree Neutral Disagree Our study 52 24% 24% Pierre (Jamaica, 2004) 68% 19% 12% Awaisu (Malaysia, 2007) 64% 24% 9% Al Omari (Jordan, 2010)28 72% 12% 15% Jawaid (Pakistan, 2014)30 76,1% 19,3% 2,8% Ameh (Nigeria, 2014)31 94,9% 4,5% 0,6% Saeed (Saudi Arabia, 2016)32 71,8% 16,7% 11,5%
Authors Agree Neutral Disagree Our study 40% 23% 37% Pierre (Jamaica, 2004) 48% 32% 20% Awaisu (Malaysia, 2007) 36% 44% 20% Ali (Egypt, 2012)33 43,1% 41,1% 12,1% Jindal (India, 2016)34 57,1% 28,5% 8,5% Saeed (KSA, 2016) 65,4% 24,4% 10,3%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
44
which cannot be extended; and if the students are not able to answer one station, they do not
have time to think about it.
In contrast to OSCE being intimidating, (71,2%) of students felt the OSCE to be less
stressful than other evaluation methods which is consistent with similar studies [2,13,30,33,34,35]. (See
Table. IV).
Table IV: OSCE less stressful than other exams
Authors Agree Neutral Disagree Our study 71,2% 0% 28,8% Pierre (Jamaica, 2004) 15% 40% 35% Awaisu (Malaysia, 2007) 41% 27% 32% Ali (Egypt, 2012)33 70,7% 10,3% 17,2% Jawaid (Pakistan, 2014) 74,3% 31 18,3% 6,4% Ameh (Nigeria, 2014) 59,6% 31,4% 9,0% Jindal (India, 2016) 82,8% 34 17,1% 0%
Despite our effort to give two briefing sessions and conduct a mock session of the OSCE,
only (55%) of the students felt that they were fully aware of the nature of the exam. This is not
consisting with other studies with relatively high rates on this fact [2,31,32,33]. (See Table.V)
Table V: Degree of awareness of nature of exam compared to other studies
Authors Agree Neutral Disagree Our Study 55% 18% 27% Pierre (Jamaica, 2004) 87% 2 9% 4% Ali (Egypt, 2012) 70,7% 33 22,4% 6,9% Ameh (Nigeria, 2014) 72,4% 31 20,5% 7,1% Saeed (Saudi Arabia, 2016) 70,5% 32 0% 19,2%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
45
Furthermore, only (36%) of the participants felt that they were aware of the level of
knowledge needed to pass the exam. These findings are lower than reports by other studies
[2,13,31,33,34,35]. (See Table.VI)
Table VI: Degree of awareness of level of knowledge needed compared to other studies
On a better note, (82%) of our group perceived that the OSCE provided an opportunity to
better learn skills and competencies. The finding that an overwhelming proportion of students
admitted that the OSCE provided a useful and practical learning experience was consistent with
similar studies reported elsewhere [2,13,26,32-35]
. (See Table.VII)
Table VII: Exam provided opportunities to learn
Authors Agree Neutral Disagree Our study 36% 20% 44% Pierre (Jamaica, 2004) 53% 2 26% 21% Awaisu (Malaysia, 2007) 54% 13 34% 12% Ali (Egypt, 2012) 55,2% 33 10,3% 32,8% Jawaid (Pakistan, 2014) 58,7% 35 27,5% 6,4% Ameh (Nigeria, 2014) 54,5% 31 30,8% 11,5% Jindal (India, 2016) 74,2% 34 14,2% 11,4%
Authors Agree Neutral Disagree Our Study 82% 9% 9% Pierre (Jamaica, 2004) 69% 2 21% 11% Ali (Egypt, 2012) 84,5% 33 22,4% 6,9% Ameh (Nigeria, 2014) 74,4% 13 1,9% 5,8% Nasir (Nigeria, 2014) 56,9% 26 28,5% 11,9% Jawaid (Pakistan, 2014) 77,1% 35 12,8% 2,8% Saeed (KSA, 2016) 79 5% 32 0% 20 5% Jindal (India, 2016) 91,4% 34 8,5% 0%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
46
ii.
Students offered constructive criticism of the structure and organization of the process.
(68%) of the participants felt that the exam was well organized with logical and appropriate
sequence of stations, which confirmed the findings of other studies
Organization and set-up of OSCE:
[2,13,28,32-35]. (See Table.VIII)
Table VIII: Perception of the OSCE’s organization compared to other studies
(52%) of students felt that the number of stations was adequate, but the response of
students on time allocated to each stations was equivocal. (45%) felt that the time allocated to
each station was enough and (41%) felt it wasn’t. Review of the literature found that Jindal34,
Awaisu13 and Pierre2 concluded that the time allocated to the stations was insufficient. The study
by Nasir26 and Jawaid35
found that the time at stations was enough. (See Table. IX)
Authors Agree Neutral Disagree
Our Study 68% 14% 18%
Pierre (Jamaica, 2004) 57% 2 30% 13%
Al Omari (Jordan, 2010) 95% 28 0% 5%
Ali (Egypt, 2012) 86,2% 33 5,2% 8,6%
Ameh (Nigeria, 2014) 90,4% 13 8,3% 1,3%
Jawaid (Pakistan, 2014) 85,3% 35 8,3% 2,8%
Saeed (KSA, 2016) 70,5% 32 19,2% 25,7%
Jindal (India, 2016) 85,7% 34 11.4% 2.8%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
47
Table IX: Perception on station time compared to other studies
The response of the students on clarity of instruction at the stations was equivocal making
interpretation difficult. Overall, (35%) of students felt that it was easy to understand written
instruction, whereas (43,8%) agreed that instructions at some station were rather ambiguous. The
literature on this matter differs widely [2,13,26,33,35]. (See Table. X)
Table X: Perception on instructions compared to other studies
Authors Agree Neutral Disagree Our study 45% 14% 41% Pierre (Jamaica, 2004) 21% 2 35% 44% Awaisu (Malaysia, 2007) 32% 13 22% 46% Al Omari (Jordan, 2010) 93% 28 4% 3% Ali (Egypt, 2012) 44,8% 33 37,9% 17,2% Ameh (Nigeria, 2014) 47,4% 13 29,5% 22,4% Nasir (Nigeria, 2014) 70,2% 26 21,9% 7,9% Jawaid (Pakistan, 2014) 64,2% 35 14,7% 2,8% Jindal (India, 2016) 20% 34 20% 59,9%
Authors Agree Neutral Disagree Our study 35,5% 20,7% 43,8% Pierre (Jamaica, 2004) 58% 2 27% 15% Ali (Egypt, 2012) 50% 33 37,9% 12,1% Ameh (Nigeria, 2014) 88,5% 13 9,0% 2,6% Nasir (Nigeria, 2014) 29,8% 26 25,8% 44,4% Jawaid (Pakistan, 2014) 76,1% 35 13,8% 3,7%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
48
i.
In our survey, students showed high satisfaction (73%) with the range of knowledge
covered by the OSCE, and this was consistent with results of other studies
Content of the OSCE:
[2,13,28,32-35]. (See
Table.XI)
Table XI: Wide area of knowledge covered
On the other hand, only (33%) of our study group felt that the skills evaluated reflected
those taught throughout the medical curriculum. This was consistent with the study by Nasir26 and
Ali33. It was not congruent with other studies findings such as Pierre2, Ameh13 and Jawaid35. (See
Table.XII)
Table XII: Skills evaluated reflected skills taught
Authors Agree Neutral Disagree Our study 73% 17% 10% Pierre (Jamaica, 2004) 95% 2 5% 0% Awaisu (Malaysia, 2007) 79% 13 20% 2% Al Omari (Jordan, 2010) 95% 28 2% 3% Ali (Egypt, 2012) 72,4% 33 5,2% 22,4% Jawaid (Pakistan, 2014) 86,2% 35 12,8% 0,9% Saeed (KSA, 2016) 82,1% 32 11,5% 6,4% Jindal (India, 2016) 94,2% 34 5,8% 0%
Authors Agree Neutral Disagree Our study 33% 22% 45% Pierre (Jamaica, 2004) 73% 2 23% 4% Ali (Egypt, 2012) 36,2% 33 32,7% 31% Ameh (Nigeria, 2014) 76,9% 13 18,6% 22,4% Nasir (Nigeria, 2014) 46,4% 26 31,8% 20,5% Jawaid (Pakistan, 2014) 61,5% 35 17,4% 4,6%
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
49
2.
As many medical schools have adopted a student-centered approach to medical education,
greater students’ participation in quality of assessment methods must be encouraged.
Limits and strengths of OSCE:
Students’ evaluation of OSCE in this study was encouraging. This was demonstrated by
favorable responses concerning its accuracy in measuring knowledge and skill, fairness of the
examination process, additional experience, and learning from the OSCE and its enhancement of
communication skills.
The majority of students saw the OSCE as an unprecedented opportunity to encounter real-
life scenarios. It also provided students with feedback mechanism to measure their strengths and
weaknesses in clinical skills.
Another advantage of OSCE is that it can be adapted according to the local needs,
departmental policies and availability of resources.
However, some might argue that personality, social relations, and gender affected their
performance and scores in the examination. Similarly, both the variability in examination venue
and that of examiner were identified by other studies [26]
In other studies
as sources of bias in scores.
[13,35], students expressed considerable concern that examiners were a
major sources of bias in scores. Checklist is meant to reduce this evaluator variability but no
matter what version of scoring is used, there is always concern for evaluator reliability and
differences between evaluator evaluations. A study from one well-established OSCE testing center
revealed the presence of 4 common evaluator errors (leniency, inconsistency, the halo effect, and
restriction of range) despite intensive evaluator training and experience [26].
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
50
The number of students aware of the nature of the exam and the knowledge needed to
pass the exam was low compared to other studies. This problem should be tackled by exposing
the students to this assessment method at an earlier stage along with the CBME approach.
By design, OSCEs were meant to lead to continuous and deep learning strategies with
incentives to practice with patients. Those expectations were not met in many studies, calling for
caution in predicting pre-assessment effects [36,37,38]. Medical students will usually align their
learning strategies to achieve the best performance in the task to come. Studies [39,40] showed that
medical students seldom practice for OSCEs through patient contact, often focusing on rehearsing
a structure rather than acquiring authentic clinical competencies. Assessment “checklists,” rather
than learning criteria, will sometimes guide students’ learning strategies [41
In another studies, students raised concern about time allocated at stations being
insufficient, and stressed that it should not become an exercise on how fast students can perform
a technique but rather focus on how well they can perform
].
Another one of its limits, is that it can lead to observer fatigue if he/she has to record the
performance of several candidates on lengthy checklists.
[34].
Studies surveying students’ attitudes during the OSCE have documented that the OSCE can
be a strong anxiety- producing experience [42], and that the level of anxiety changes little as
students progress through the examination. However, students’ perception of the OSCE may have
been influenced by anxiety and lack of confidence associated with a new assessment format. This
was understandable, as it was their first encounter with this type of assessment [26]
Another disadvantage of the OSCE is its high cost and its time-consumerism. In our study
.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
51
it was not possible to calculate the exact cost. However, it is important to highlight that it required
additional effort from the faculty. This was also the case with other studies [43
Another concern, is that the students desire more feedback on their performance and this
should be included in our OSCE experience
].
[44
Another recurrent concern of this approach is that the student’s skills and knowledge are
being put into compartments and that he is being discouraged from looking at the patient as
whole
].
[8, 13]
3.
.
Like any other assessment method, OSCE presents with some flaws that makes it unfit to
rely on it solely
Recommendations for improvement of the OSCE:
[45]. The findings of this study strengthen the findings of previous studies which
emphasized on the use of multiple tests rather than just a single test to make judgment on
students’ performance especially in high stakes examination. The existence of both examination
formats could help in making a more comprehensive decision on student’s [24]
OSCE should be used both as summative and a formative tool, which would make it
primarily a learning tool and would not contribute to a student’s final assessment mark. It would
also be an opportunity to familiarise students with the OSCE process early in their curriculum and
to provide feedback on their performance, thereby enabling improvement before the summative
OSCE.
.
The value of such formative assessment in higher education is well documented. It is
important to distinguish between mock OSCEs and formative OSCEs, as they serve different
purposes and have different educational outcomes. A mock OSCE replicates the summative OSCE,
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
52
allowing students to experience the timings, format, layout, length, and station content of a
summative OSCE. A formative OSCE, however, may take a different format or length to a
summative OSCE, and is primarily designed to enhance learning of clinical and examination skills.
A formative OSCE may be helpful to identify struggling students to enable additional
support prior to any summative OSCE. In general, the formative OSCE was viewed as a positive and
useful activity, with the majority of students applying their learning experience to their preparation
for the summative OSCE. Students clearly appreciate the opportunity to practise their clinical and
examination skills under the ‘low-risk’ conditions of a formative exam [46
Another suggestion, would be to integrate simulation-based learning into OSCEs. Such a
combination already exists in the form of TIPS: The Test of Integrated Professional Skills which is
an OSCE-Simulation Hybrid exam using standardized patient interactions and skill performance to
assess a range of skills in order to generate personalized learning plans
].
[47
].
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
53
CONCLUSION
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
54
Although the implementation of the OSCE in the FMPM has been challenging, considering
the heavy logistics and costs it requires; and the fact that it was the first time students
encountered this type of evaluation method; the findings of our study demonstrates an overall
acceptance and satisfaction with this method.
This appears in student feedback which confirmed their acceptance of OSCE, stating that it
was fair, unbiased, covers a wide range of knowledge and is comprehensive tool for assessment.
The students′ noted that, the exam was well-structure and sequence, provide opportunities to
learning experience and reflected real life situation. Also the majority of examinees was satisfied
with conduct, organization and administration of the OSCE; as well prefer using the OSCE exam
more in the clinical exams than other assessment tools.
The survey further highlighted for future refinement, the strengths and weaknesses
associated with the development and implementation of an OSCE.
In light of this finding, it is recommended that the OSCE must be used as an integral part of
the overall assessment strategy and introduced to students earlier in their studies; moreover, the
OSCE shouldn’t be relied on solely and should be used it in conjunction with other classical clinical
examination methods.
More studies are required involving larger number of students and teachers to further
establish the effectiveness of the OSCE within the undergraduates’ medical curriculum.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
55
APPENDICES
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
56
APPENDIX : QUESTIONNAIRE
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
57
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
58
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
59
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
60
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
61
APPENDIX : OB-GYN SAMPLE STATION
ECOS de gynécologie obstétrique Contraception
Station : 1. Type de station : demande de contraception. 2. Durée : 05 minutes
3. Matériel nécessaire :
• Un bureau
• Deux chaises : une pour le candidat, une autre pour l’évaluateur.
4. Documents :
• Feuille de l’énoncé.
• Scenario
• Grille d’évaluation.
5. Scénario :
• Situation clinique : consultation de contraception
• Enoncé : Madame Fatima, vous consulte pour demande de contraception. Vous avez 05 minutes pour relever les éléments anamnestiques et l’aider à choisir la contraception adéquate
• Script pour la patiente simulée :
Fatima, 34 ans Mariée depuis 10 ans 3 grossesses, 2acouchement et une fausse couche
• 1ere grossesse : accouchement par voie basse sans anomalies, garçon vivant de 8 ans
• 2eme grossesse : accouchement par voie basse, fille de 2 ans • 3eme grossesse : FC spontanée, il y a 1an
ATCD de thrombophlébite surale traitée il y a 2 ans au cours de la
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
62
items
APPENDIX : MARKING SHEET SAMPLE FOR THE EVALUATOR (WITHOUT SCORING)
fait Non fait
Interrogatoire précis :
Age
Gestité et parité
Date des dernières règles
Contraception antérieure
ATCD thrombophlébite personnel
ATCD thrombophlébite familial
HTA
Diabète
Migraine
Contexte IST Prise médicamenteuse
Prise Anticoagulant
Dysménorrhées ménorragies
Durée désirée de contraception
synthèse Proposer des moyens contraceptifs : DIU
Explications DIU
Proposer des moyens contraceptifs : micro progestatif
Explications micro progestatifs
Proposer des moyens contraceptifs : implant
explications
Citer que les oestroprogestatifs sont CI
Proposer les oestroprogestatifs
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
63
Demander le choix de la patiente Expliquer les effets secondaires du moyen choisi
Expliquer le mode d’utilisation Se présenter
Demande objectif de la visite
Impression globale sur l’attitude
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
64
items
APPENDIX : MARKING SHEET SAMPLE FOR THE TEACHER REPONSIBLE FOR THE STATION (WITH SCORING)
fait Non fait
Interrogatoire précis :
Age 2
Gestité et parité 2
Date des dernières règles 2
Contraception antérieure 3
ATCD thrombophlébite personnel 3
ATCD thrombophlébite familial 2
HTA 3
Diabète 3
Migraine 4
Contexte IST 4 Prise médicamenteuse 3
Prise Anticoagulant 3
Dysménorrhées 4 ménorragies 4
Durée désirée de contraception 4
synthèse 4 Proposer des moyens contraceptifs : DIU 4
Explications DIU 4
Proposer des moyens contraceptifs : micro progestatif 4
Explications micro progestatifs 4
Proposer des moyens contraceptifs : implant 2
explications 2
Citer que les oestroprogestatifs sont CI 6
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
65
Proposer les oestroprogestatifs - 10
Demander le choix de la patiente 5 Expliquer les effets secondaires du moyen choisi 5
Expliquer le mode d’utilisation 4 Se présenter 3
Demande objectif de la visite 3
Impression globale sur l’attitude 4
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
66
APPENDIX : STATION EXAMPLE
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
67
APPENDIX : MARKING SHEET SAMPLE FOR THE EVALUATOR (WITHOUT SCORING)
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
68
APPENDIX : MARKING SHEET SAMPLE FOR THE TEACHER REPONSIBLE FOR THE STATION (WITHSCORING)
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
69
APPENDIX : EXEMPLE OF STATION SETTING
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
70
APPENDIX : CONFIGURATION OF A STATION
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
71
List of figures :
Figure1: Year of study Figure2: Students’ status Figure3: Student’s view on exam’s fairness Figure4: Student’s level of stress during the exam Figure5: Exam increases chances of passing Figure6: Exam is intimidating Figure7: Perception of stress comparing TCE and OSCE for students who only experienced OSCE Figure7 bis: Perception of stress comparing TCE and OSCE for students who experienced both TCE and OSE Figure8: Preference of students between OSCE and TCE Figure9: Student’s awareness of the nature of the exam Figure10: Student’s awareness of level of knowledge needed for the exam Figure11: Student’s perception of exam providing opportunity a better way to learn some competencies Figure12: Difficulty to prepare for the exam Figure13: Student’s opinion about the organization of the OSCE Figure14: Student’s opinion about the number of stations Figure15: Student’s opinion about time allocated to each station Figure16: Student’s opinion about the instructions at the stations Figure17: Student’s opinion about the stations with SPs Figure18: Exam covers a wide area of competencies Figure19: Clinical competencies reflected those taught Figure20: Clinical competencies evaluated reflected those needed for a general doctor Figure21: Miller’s pyramid of Assessment Figure22: OSCE workshop at the pedagogy department Figure23: A OSCE mock session Figure24: Center for Simulation and Innovation in Health Sciences (CSISS) of the Faculty of Medicine and Pharmacy of Marrakech. Figure25: OSCE committee preparation meeting Figure26 : Examination venue Figure27: Directions and number of stations Figure28: U-shaped setting of stations Figure29: Coordination committee station Figure30: Anamnesis station, with the examinee, the SP, the evaluator and the head of the station Figure31: Dry station with the examinee, the examiner and the head of the station Figure32: Procedural station; here we have a student performing a pap smear. Figure33: Student performing a breast examination on a manikin Figure34: Dry station; interpretation of a mammography
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
72
List of tables :
Table I: Medical undergraduates’ students’ evaluation of OSCE attributes Table II: Exam’s fairness compared to other studies Table III: Exam being intimidating compared to other studies Table IV: OSCE less stressful than other exams Table V: Degree of awareness of nature of exam compared to other studies Table VI: Degree of awareness of level of knowledge needed compared to other studies Table VII: Exam provided opportunities to learn Table VIII: Perception of the OSCE’s organization compared to other studies Table IX: Perception on station time compared to other studies Table X: Perception on instructions compared to other studies Table XI: Wide area of knowledge covered
Table XII: Skills evaluated reflected skills taught
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
73
ABSTRACT
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
74
The aim of this study was to investigate the students′ perception of the OSCE as part of an
evaluation of clinical skills in undergraduates’ medical students in their final year of the
curriculum. A self-administered questionnaire inspired by a Pierre et al.
Abstract:
questionnaire was sent to
students via Facebook and distributed to some right after the completion of the OSCE. The
questionnaire was composed of 4 sections and 32 items, with questions about the examination’s
fairness, organization, validity, objectivity and content. The results of this study indicates that
OSCE has been viewed as a relatively fair assessment tool (52%), that it minimized the chance of
failing (83%) and covered a wide range of knowledge (73%). However, some students felt that OSCE
was intimidating (40%), that it was difficult to prepare for the exam (58,2%) and (41%) of student
expressed concerns about inadequacy of time. Moreover, the students felt that the OSCE provided
opportunities to better learn skills (82%) but didn’t feel that the skills evaluated reflected those
which were taught (45%). (68%) reported that the stations were well organized and of logical
sequence. (52%) of student felt that the SPs stations were authentic and (51%) of them agreed that
the skills evaluated reflected those needed for a general practitioner. Student feedback confirmed
their acceptance of OSCE as an evaluation tool for their clinical skills, so as to fairness and
unbiased, cover a wide range of knowledge and comprehensive, provide opportunities to leaning.
Also the majority of examinees was satisfied with organization and administration of the OSCE,
they preferred using the OSCE exam more in the clinical exams than the other assessment. More
studies are required involving larger number of students and teachers to further establish the
effectiveness of OSCE within medical curriculum.
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
75
Le but de cette étude était de faire une enquête sur la perception des étudiants par rapport aux
ECOS dans le cadre de l’évaluation des compétences cliniques chez les étudiants en médecine en
dernière année de cursus. Un questionnaire auto-administré inspiré par Pierre (Jamaïque, 2004) a
été envoyé aux étudiants via Facebook et distribué à certains juste après la fin des ECOS. Le
questionnaire était composé de 4 sections et de 32 items, avec des questions sur l'équité,
l'organisation, la validité, l'objectivité et le contenu de l'examen. Les résultats de cette étude
indiquent que l’ECOS a été considéré comme un outil d'évaluation relativement équitable (52%),
que cette méthode minimisait les risques d'échec (83%) et couvrait un large éventail de
connaissances (73%). Cependant, certains étudiants ont estimé que l’ECOS était intimidant (40%),
qu'il était difficile de se préparer à l'examen (58,2%) et (41%) des étudiants ont exprimé des
inquiétudes quant au manque de temps. De plus, les étudiants ont estimé que l'ECOS offrait des
possibilités de mieux acquérir certaines compétences (82%) mais ne pensaient pas que les
compétences évaluées reflétaient celles qui avaient été enseignées (45%). (68%) ont signalé que les
stations étaient bien organisées et de séquence logique. (52%) des étudiants estimaient que les
stations de SP étaient authentiques et (51%) d'entre eux étaient d'accord que les compétences
évaluées reflétaient celles requises pour un praticien généraliste. Les commentaires des étudiants
ont confirmé leur acceptation de l'ECOS en tant qu'outil d'évaluation de leurs compétences
cliniques, en étant équitable et impartial, de couvrir un large éventail de connaissances et d'offrir
des possibilités d'apprentissage. La majorité des candidats étaient satisfaits de l'organisation et de
l'administration de l’ECOS, ils ont en outre préféré cette méthode à d’autres méthodes
d’évaluation clinique. Plus d'études sont nécessaires impliquant un plus grand nombre d'étudiants
et d'enseignants pour établir davantage l'efficacité de l'OSCE dans le cursus médical.
RESUME :
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
76
ملخص
المهارات تقييم كأداة موضعي البناء سريريعن التقييم ال الطالب وجهة نظر من التحقق الدراسة هذه من الغرض كان
إلى اجامايك بيير من مستوحى اإلدارة ذاتي استبيان إرسال تم. دراستهم من النهائية السنة في الطب لطالب سريريةال
بنًدا، 32و أقسام 4 من االستبيان يتكون. موضعي البناء سريريال التقييم انتهاء بعد البعض على وتوزيعهفيسبوك الطالب عبر
التقييم أن إلى الدراسة هذه نتائج تشير. االختبار ومحتوى والموضوعية والصالحية والتنظيم اإلنصاف حول أسئلة عم
وغطت) ٪83( الفشل خطر من قللت الطريقة هذه وأن ،)٪52( نسبياً عادلة تقييم أداة تعتبر موضعي البناء سريريال
،)٪ 40( تخيف كانت موضعي البناء سريريالالتقييم أن الطالب بعض شعر ،ذلك ومع .)٪73( المعرفة من واسعة مجموعة
إلى باإلضافة. الوقت وجود عدم إزاء قلقه عن أعرب الطالب من) ٪ 41( و) ٪ 58.2( لالمتحان التحضير الصعب من كان وأنه
،)٪82( أفضل بشكل معينة مهارات على للحصول فرًصا أتاحت قد موضعي البناء سريريال التقييم بأن الطالب شعر ،ذلك
المحطات أن الطالب من )٪ 68( ذكر). ٪45( تدريسها تم التي تلك تعكس تقييمها تم التي المهارات أن يعتقدون ال لكنهم
المحطات بأن شعروا الطالب من) ٪52. (ومنطقية جيدا تنظيما منظمة كانت PS المهارات أن على اتفقوا) ٪51( و أصلية كانت
مهاراتهم لتقييم كأداة الطالب من قبولهم الطالب فعل ردود أكدت. عام طبيبل المطلوبة تلك تعكس تقييمها تم التي
عن راضية المتقدمين غالبية كانت. التعلم فرص وتوفر المعرفة من واسعة مجموعة تغطي ،ومحايدة نزيهة وكونها ،ةسريريال
من لمزيد حاجة هناك. السريري للتقييم أخرى طرق على الطريقة هذه وفضلوا ،البناءموضعي سريريالالتقييم وإدارة تنظيم
الطبية المناهج في موضعي البناء سريريالتقييم ال فعالية لتعزيز والمعلمين الطالب من المزيد تشمل التي الدراسات .
The OSCEs in Gynecology-Obstetrics: about the experience of the Faculty of Medicine of Marrakech
77
BIBLIOGRAPHY
1. Harden RM.
Revisiting ‘Assessment of clinical competence using an objective structured clinical examination (OSCE)’. Medical education. 2016 Apr ;50(4) :376-9
2. Pierre RB, Wierenga A, Barton M, Branday JM, Christie CD. Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica. BMC medical education. 2004 Dec;4(1):22
3. Stokes JF. The clinical examination: assessment of clinical skills. Association for the Study of Medical Education; 1974.
4. Wilson GM, Lever R, Harden RM, Robertson JI, MacRitchie J. Examination of clinical examiners. The Lancet. 1969 Jan 4;293(7584):37-40
5. Hubbard JP. Measuring medical education. Philadelphia: Lea & Febiger. 1971
6. Marshall VR, Ludbrook J.
The relative importance of patient and examiner variability in a test of clinical skills. Medical Education. 1972 Sep 1;6(3):212-7.
7. https://mcc.ca/examinations/osce-orientation/history/ 8. Harden RM, Stevenson M, Downie WW, Wilson GM.
Assessment of clinical competence using objective structured examination. British Medical Journal 1975 Feb;1(5955):447-451.
9. Bartfay WJ, Rombough R, Howse E, LeBlanc R. The OSCE approach in nursing education: Objective structured clinical examinations can be effective vehicles for nursing education and practice by promoting the mastery of clinical skills and decision-making in controlled and safe learning environments. The Canadian Nurse. 2004 Mar 1;100(3):18
10. Solà M, Pulpón AM, Morin V, Sancho R, Clèries X, Fabrellas N. Towards the implementation of OSCE in undergraduate nursing curriculum: A qualitative study. Nurse education today. 2017 Feb 1;49:163-7
11. Schoonheim‐Klein M, Walmsley AD, Habets LL, Van der Velden U, Manogue M.
An implementation strategy for introducing an OSCE into a dental school. European Journal of Dental Education. 2005 Nov 1;9(4):143-9
12. Webster M, Remedios L.
Reflection and feedback during my OSCE: what have I learnt?. Physiotherapy. 2015 May 1;101:e1273.
13. Awaisu A, Nik Mohamed MH, Mohammad Al-Efan QA. Perception of pharmacy students in Malaysia on the use of objective structured clinical examinations to evaluate competence. American journal of pharmaceutical education. 2007 Sep;71(6):118.
14. The Objective Structured Clinical Examination (OSCE) Review Project Annotated Bibliography and Structured Contents Analysis 01/2/02 – 31/5/02
15. Harden RM.
What is an OSCE?. Medical teacher. 1988 Jan 1;10(1):19-22.
16. Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Medical education. 1979 Jan 1;13(1):39-54.
17. Projet de Réforme des Etudes Médicales, Pharmaceutiques et Odontologiques Note de synyhèse des 3 filières 17 mai 2015 Doyens des Facultés de Médecine et de Pharmacie Doyens des Facultés de Médecine Dentaire. http://wd.fmpm.uca.ma/fmpm/pedag_eva/reforme/projet_reforme.pdf
18. Soanes C, Stevenson A, editors.
The Oxford Dictionary of English. Revised Edition. Oxford, UK: Oxford University Press; 2005.
19. Frank JR, Mungroo R, Ahmad Y, Wang M, De Rossi S, Horsley T. Toward a definition of competency-based education in medicine: a systematic review of published definitions. Medical teacher. 2010 Aug 1;32(8):631-7.
20. Shah, N., Desai, C., Jorwekar, G., Badyal, D. and Singh, T.
Competency-based medical education: An overview and application in pharmacology. Indian journal of pharmacology, 2006, 48(Suppl 1), p.S5.
21. Ramani S, Leinster S.
AMEE Guide no. 34: Teaching in the clinical environment. Medical teacher. 2008 Jan 1;30(4):347-64
22. Turner JL, Dankoski ME.
Objective structured clinical exams: a critical review. Fam Med. 2008 Sep 1;40(8):574-8.
23. Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The objective structured clinical examination (OSCE): AMEE guide no. 81. Part II: organisation & administration. Medical teacher. 2013 Sep 1;35(9):e1447-63
24. Skrzypek A, Szeliga M, Stalmach-Przygoda A, Górski S, Kowalska B, Kocurek A, Nowakowski M. The Objective Structured Clinical Examination (OSCE) from the perspective of 3rd year's medical students-a pilot study. Folia medica Cracoviensia. 2017;57(3):67-75
25. Khorashad AK, Salari S, Baharvahdat H, Hejazi S, Lari SM, Salari M, Mazloomi M, Lari SM.
The assessment of undergraduate medical students’ satisfaction levels with the objective structured clinical examination. Iranian Red Crescent Medical Journal. 2014 Aug;16(8)
26. Nasir AA, Yusuf AS, Abdur-Rahman LO, Babalola OM, Adeyeye AA, Popoola AA, Adeniran
JO. Medical students’ perception of objective structured clinical examination: a feedback for process improvement. Journal of surgical education. 2014 Sep 1;71(5):701-6.
27. Ibrahim NK, Al-Sharabi BM, Al-Asiri RA, Alotaibi NA, Al-Husaini WI, Al-Khajah HA, Rakkah RM, Turkistani AM. Perceptions of clinical years’ medical students and interns towards assessment methods used in King Abdulaziz University, Jeddah. Pakistan journal of medical sciences. 2015 Jul;31(4):757
28. Omari AL, Shawagfa ZM. New experience with objective structured clinical examination in Jordan. RMJ. 2010 Jan;35(1):78-81
29. Idris SA, Hamza AA, Elhaj MA, Elsiddig KE, Hafiz MM, Adam ME. Students’ perception of surgical objective structured clinical examination (OSCE) at final year MBBS, University of Khartoum, Sudan. Medicine Journal. 2014 Mar 6;1(1):17-20
30. Jawaid M, Masood Z, Jaleel F.
STUDENTS’PERCEPTION OF SURGICAL OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE) AT DOW UNIVERSITY OF HEALTH SCIENCES. Journal of Postgraduate Medical Institute (Peshawar-Pakistan). 2014 Jan 14;28(1)
31. Ameh N, Abdul MA, Adesiyun GA, Avidime S. Objective structured clinical examination vs traditional clinical examination: an evaluation of students’ perception and preference in a Nigerian medical school. Nigerian medical journal: journal of the Nigeria Medical Association. 2014 Jul;55(4):310
32. Saeed AA, Al Suwayh WM, Alomri AS.
Students' perceptions and attitudes towards Objective Structured Clinical Examination (OSCE) in the College of Medicine, KSAU-HS, King Fahad Medical City, Riyadh, Saudi Arabia. Journal of Medical Science And clinical Research. 2016.
33. Ali G, Mehdi AY, Ali H.
Objective structured clinical examination (OSCE) as an assessment tool for clinical skills in Sohag University: Nursing students’ perspective. JES. 2012;8:59-69.
34. Jindal P, Khurana G.
The opinion of post graduate students on objective structured clinical examination in Anaesthesiology: a preliminary report. Indian journal of anaesthesia. 2016 Mar;60(3):168
35. Huang YS, Liu M, Huang CH, Liu KM.
Implementation of an OSCE at Kaohsiung Medical University. The Kaohsiung journal of medical sciences. 2007 Apr 1;23(4):161-9
36. Al Kadri HM, Al-Moamary MS, Elzubair M, Magzoub ME, AlMutairi A, Roberts C, van der
Vleuten C. Exploring factors affecting undergraduate medical students’ study strategies in the clinical years: a qualitative study. Advances in health sciences education. 2011 Dec 1;16(5):553-67.
37. Norton* L.
Using assessment criteria as learning criteria: a case study in psychology. Assessment & Evaluation in Higher Education. 2004 Dec 1;29(6):687-702
38. May W, Chung EK, Elliott D, Fisher D.
The relationship between medical students’ learning approaches and performance on a summative high-stakes clinical performance examination. Medical Teacher. 2012 Apr 1;34(4):e236-41.
39. Cilliers FJ, Schuwirth LW, Herman N, Adendorff HJ, van der Vleuten CP. A model of the pre-assessment learning effects of summative assessment in medical education. Advances in Health Sciences Education. 2012 Mar 1;17(1):39-53.
40. Rudland J, Wilkinson T, Smith-Han K, Thompson-Fawcett M. “You can do it late at night or in the morning. You can do it at home, I did it with my flatmate.” The educational impact of an OSCE. Medical teacher. 2008 Jan 1;30(2):206-11
41. Lafleur A, Laflamme J, Leppink J, Côté L.
Task demands in OSCEs influence learning strategies. Teaching and learning in medicine. 2017 Jul 3;29(3):286-95
42. Kalantari M, Zadeh NL, Agahi RH, Navabi N, Hashemipour MA, Nassab AH.
Measurement of the levels anxiety, self-perception of preparation and expectations for success using an objective structured clinical examination, a written examination, and a preclinical preparation test in Kerman dental students. Journal of education and health promotion. 2017;6
43. Alaidarous S, Mohamed TA, Masuadi E, Wali S, AlMalki A.
Saudi Internal Medicine Residents׳ Perceptions of the Objective Structured Clinical Examination as a Formative Assessment Tool. Health Professions Education. 2016 Dec 1;2(2):121-9
44. Duffield KE, Spencer JA.
A survey of medical students’ views about the purposes and fairness of assessment. Medical education. 2002 Sep 1;36(9):879-86
45. Rushforth HE. Objective structured clinical examination (OSCE): review of literature and implications for nursing education. Nurse education today. 2007 Jul 1;27(5):481-90.
46. Chisnall B, Vince T, Hall S, Tribe R. Evaluation of outcomes of a formative objective structured clinical examination for second-year UK medical students. International journal of medical education. 2015;6:76.
47. Winkel AF, Niles P, Lerner V, Zabar S, Szyld D, Squires A.
Notes from the Field: Residents’ Perceptions of Simulation-Based Skills Assessment in Obstetrics and Gynecology. Evaluation & the health professions. 2016 Mar;39(1):121-5
قسم الطبيب
سقسم هلل العظيم
سن سراقب هللا في مهنتي
كلفة سدوارهل في كل الظروف وسن سصون حيلة اإلنسلن في واألحوال
هلذالً وسعي في استنقلذهل من الهالك والمرض واأللم والقلق
وسن سحفظ للنلس كرامتهم، وسستر عورتهم، وسكتم سرهم وسن سكون على الدوام من وسلئل رحمة هللا، هلذالً رعليتي الطبية للقريب والبعيد،
للصللح والخلطئ، والصديق والعدوال ألذاه.. ر على طلب العلم، سسخره لنفع اإلنسلنوسن سثله
وسن سوقر من علمني، وسعلم من يصغرني، وسكون سخًل لكل زميل في المهنة الطبية
متعلونين على البر والتقوىوسن تكون حيلتي مصداق إيملني في سري وعالنيتي ، نقيًة
ممل يشينهل تجله هللا ورسوله والمؤمنين
هيدوهللا على مل سقول ش
209رقم اطروحة 2018نة س
: التقييم السريري موضعي البناء في طب النساء و التوليد حول تجربة كلية الطب و الصيدلة بمراكش
22/06/2018عالنية يوم قدمت و نوقشت
من طرفأسماء خاوا: اآلنسة
لنيل شهادة الدكتوراه في الطب
:الكلمات االساسية التكوين الطبي ـ تقييم ـ التقييم السريري موضعي البناء
اللجنة
الرئيس السوماني. السيد أ أستاذ في أمراض النساء و التوليد
المشرف هارو. السيد ك ساء و التوليدأستاذ في أمراض الن
الحكام أسموكي. السيد ح أستاذ في أمراض النساء و التوليد
top related